NC AG Bell Membership Survey

Thank you so much for taking time to respond to this brief survey. We truly appreciate your time and valuable input. We look forward to leading the NC Chapter of AG Bell in the next three years.

The NC AG Bell Board

Sherri Vernelson
Megan Katz
Stephanie Sjoblad
Beth Cash
Holly Shoun
Lisa Di Maria
Holly Teagle

1. Please help us to understand a little about who you are. Check all that apply.

Are you:

Please help us to understand a little about who you are. Check all that apply. Are you: a parent of a child with hearing loss	a professional who works with children with hearing loss	a person with hearing loss
Other (please specify)

2. What age group is most pertinent to you in your role as an advocate for people with hearing loss? Check all that apply.

What age group is most pertinent to you in your role as an advocate for people with hearing loss? Check all that apply. Young Children (birth to 5 years old)

Elementary School Age Children (6 - 12 years old)

Teens and Adolescents (13 - 22 years old)

Young Adults (23 - 29 years old)

Adults (30 years and older)

3. Would you be willing serve as a volunteer to achieve the goals and objectives of the NC Chapter of AG Bell?

Would you be willing serve as a volunteer to achieve the goals and objectives of the NC Chapter of AG Bell? yes

4. Would you be willing to lead a committee to coordinate volunteer efforts to achieve the goals and objectives of NC AG Bell, so that we could have a broader impact on children with hearing loss across the state of North Carolina?

Would you be willing to lead a committee to coordinate volunteer efforts to achieve the goals and objectives of NC AG Bell, so that we could have a broader impact on children with hearing loss across the state of North Carolina? yes	no
Other (please specify)

5. In case we need to contact you about volunteer opportunities, please provide the following information.

In case we need to contact you about volunteer opportunities, please provide the following information. Name:
City/Town:
Email Address:
Phone Number:

6. In your opinion, what would be a useful goal that NC AG Bell could adopt and achieve in the next three years? For young children? For teens and/or young adults? For adults? For bilingual families?

In your opinion, what would be a useful goal that NC AG Bell could adopt and achieve in the next three years? For young children? For teens and/or young adults? For adults? For bilingual families?

7. What type of information would be most helpful to have available on the NC AG Bell website and/or Facebook page?

What type of information would be most helpful to have available on the NC AG Bell website and/or Facebook page?

8. Please submit any additional comments, questions or suggestions here. Thank you again for you participation in this survey.

Please submit any additional comments, questions or suggestions here. Thank you again for you participation in this survey.

1. NC AG Bell Membership Survey

1. Please help us to understand a little about who you are. Check all that apply.Are you: